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LIS > Bill Tracking > HB1290 > 2020 session
lis.virginia.gov
100-0 win. We are coming after you. State by state.
We are coming after you
Started by VictorOfHungerGames
100-0 win. We are coming after you. State by state.
Sorry mod, you can move this to pharmacy forum. Didn't realize I was in prepharm.
This is great news. A lot of legal language... Does this include language to regulate reimbursement?
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I think the whole point was to expose them of their opaque nature. If they follow the law, reimbursements should not have tanked in the first place. By having them be licensed, it would be much easier to monitor their activities and regulate their illegal ways of reimbursement.
You think pharmacists getting licensed from NABP by passing the NAPLEX or becoming licensed specialists by passing the BCPS provides any sort of quality control when it comes to the competencies of pharmacists? I think not.
Let's face it, any licensing agency (in pharmacy, anyways) only exists only to make money and cares less about anything else such as patient care/safety. Chances are, if some PBM licensing regulations go into place, the PBMs will just pay a fee and continue to do what they've been doing. The PBMs are happy, the licensing agency is happy, and pharmacies continue to lose and close down.
If the following can be enforced -
"A. No carrier on its own or through its contracted pharmacy benefits manager or representative of a pharmacy benefits manager shall:
1. Cause or knowingly permit the use of any advertisement, promotion, solicitation, representation, proposal, or offer that is untrue;
2. Charge a pharmacist or pharmacy a fee related to the adjudication of a claim other than a reasonable fee for an initial claim submission;
3. Reimburse a pharmacy or pharmacist an amount less than the amount that the pharmacy benefits manager reimburses a pharmacy benefits manager affiliate for providing the same pharmacist services, calculated on a per-unit basis using the same generic product identifier or generic code number and reflecting all drug manufacturer's rebates, direct and indirect administrative fees, and costs and any remuneration; or
4. Penalize or retaliate against a pharmacist or pharmacy for exercising rights provided pursuant to the provisions of this article.
B. No carrier, on its own or through its contracted pharmacy benefits manager or representative of a pharmacy benefits manager, shall restrict participation of a pharmacy in a pharmacy network for provider accreditation standards or certification requirements if a pharmacist meets such accreditation standards or certification standards.
C. No carrier, on its own or through its contracted pharmacy benefits manager or representative of a pharmacy benefits manager, shall include any mail order pharmacy or pharmacy benefits manager affiliate in calculating or determining network adequacy under any law or contract in the Commonwealth.
D. No carrier, on its own or through its contracted pharmacy benefits manager or representative of a pharmacy benefits manager, shall conduct spread pricing in the Commonwealth."
then this law will be meaningful. I'm cautiously optimistic about PBM reform.
ALSO, serious question here, it seems that Walgreens has a lot to gain from PBM reform. If it were in fact against the law to engage in spread pricing, pharmacy steering, clawbacks, etc., wouldn't it be in Walgreens' best interest to take any PBM they find breaking the law straight to court? Large grocery chains would also have some legal muscle to flex here. It wouldn't simply be the regulatory bodies holding PBMs feet to the fire.
"A. No carrier on its own or through its contracted pharmacy benefits manager or representative of a pharmacy benefits manager shall:
1. Cause or knowingly permit the use of any advertisement, promotion, solicitation, representation, proposal, or offer that is untrue;
2. Charge a pharmacist or pharmacy a fee related to the adjudication of a claim other than a reasonable fee for an initial claim submission;
3. Reimburse a pharmacy or pharmacist an amount less than the amount that the pharmacy benefits manager reimburses a pharmacy benefits manager affiliate for providing the same pharmacist services, calculated on a per-unit basis using the same generic product identifier or generic code number and reflecting all drug manufacturer's rebates, direct and indirect administrative fees, and costs and any remuneration; or
4. Penalize or retaliate against a pharmacist or pharmacy for exercising rights provided pursuant to the provisions of this article.
B. No carrier, on its own or through its contracted pharmacy benefits manager or representative of a pharmacy benefits manager, shall restrict participation of a pharmacy in a pharmacy network for provider accreditation standards or certification requirements if a pharmacist meets such accreditation standards or certification standards.
C. No carrier, on its own or through its contracted pharmacy benefits manager or representative of a pharmacy benefits manager, shall include any mail order pharmacy or pharmacy benefits manager affiliate in calculating or determining network adequacy under any law or contract in the Commonwealth.
D. No carrier, on its own or through its contracted pharmacy benefits manager or representative of a pharmacy benefits manager, shall conduct spread pricing in the Commonwealth."
then this law will be meaningful. I'm cautiously optimistic about PBM reform.
ALSO, serious question here, it seems that Walgreens has a lot to gain from PBM reform. If it were in fact against the law to engage in spread pricing, pharmacy steering, clawbacks, etc., wouldn't it be in Walgreens' best interest to take any PBM they find breaking the law straight to court? Large grocery chains would also have some legal muscle to flex here. It wouldn't simply be the regulatory bodies holding PBMs feet to the fire.
My biggest concern would be what PBMs will do until the laws are effective. I'm thinking they can go on a purge until 1/1/2021 where they'll just hoard as much money as they could. If above laws are enforced and playing fields are leveled, one could assume that chains that own PBMs like cvs could take the biggest hit. Considering that caremark is reimbursing higher for cvs compared to others.
If there were massive PBM reforms then it will be interesting to see how CVS deals with it. My prediction is that they will continue to cut labor costs on the pharmacy side of the business to generate the capital needed to pay off whatever fines, taxes etc. they are accountable for. After all, imagine how much money you can save by cutting the salaries of 30,000+ pharmacists by $5/hr each.
It’s about damn time
Missouri Pharmacy Association backs legislation aimed at regulating pharmacy benefit managers
JEFFERSON CITY, Mo. – The Missouri Pharmacy Association is calling for more regulations on pharmacy benefit managers (PBMs). PBMs manage prescription drug benefits for health insurers. The Missouri…
fox2now.com
Snowballing has begun.
No it does not. But as I posted above, more states are going after PBMs. Here in Texas, there is a PBM reform legislation which should pass based on how other states are handling.
DIR FEES - Direct and Indirect Remuneration Fee - NACDS
DIR fees are an acronym for Direct and Indirect Remuneration Fee. These fees are the result of a loophole in Medicare regulations.
www.nacds.org
Didn't CMS shoot down proposed DIR fee reforms last year? Not sure what their rationale is but while we're playing the blame game how about we blame the government as well?DIR FEES - Direct and Indirect Remuneration Fee - NACDS
DIR fees are an acronym for Direct and Indirect Remuneration Fee. These fees are the result of a loophole in Medicare regulations.www.nacds.org
Hmmm not sure about CMS shooting it down. Haven't heard anything about that. Federal government involvement has been pretty recent and based on that article, bipartisan package in attacking PBM just got done back in December of 2019. Sounds every pharmacy organization and their moms are involved in the pbm reform so just a matter of time.
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Did a quick search and this is what I found:
Duane Morris LLP - CMS Final Rule Fails to Implement DIR Fee Reform
This was done in May of 2019. The recent reform was later and still on going. We shall see where this goes.Did a quick search and this is what I found:
Duane Morris LLP - CMS Final Rule Fails to Implement DIR Fee Reform
www.duanemorris.com
Right. My point was that if a bill for DIR fee relief was shot down last year for reasons unknown, then unless those reasons have changed in the last few months I don't see why the 2020 version would pass either.
Also this is probably a long shot but if Bernie Sanders becomes president in 2020 then the bill might be shot altogether.
True but I feel like there is more collective effort this time. It's not just on federal level but state and local level as well.
Passed 96-0 in Wisconsin assembly. Now on to the Senate. Breaking - WI Assembly Votes 96-0 Passing Legislation to Lower Prescription Drug Costs by Regulating PBMs - Milwaukee Community Journal
I hope so. Our monthly DIRs fees have gone from around 5k a month to around 13k so far this year.
"Members of the Wisconsin Pharmacy Patient Protection Coalition include: American Cancer Society Cancer Action Network; American Diabetes Association; AIDS Resource Center of Wisconsin; Coalition of Wisconsin Aging and Health Groups; Epilepsy Foundation; Great Lakes Hemophilia Foundation, Hometown Pharmacy; Lupus Foundation of America, Wisconsin Chapter; National Infusion Center; National Multiple Sclerosis Society; Pharmacy Society of Wisconsin; Wisconsin Alliance for Women’s Health; Wisconsin Medical Society, Wisconsin Rheumatology Association and the Wisconsin Association of Osteopathic Physicians & Surgeons. "
Damn that's what you call a coalition lol
The night is darkest just before dawn. Hang in there. Change is coming. PBMs know it's gonna come down hard on them. They're freaking out.
Some more good news from Kentucky today:
A good majority of these bills are passing with unanimous votes. I'm an avowed pessimist, but I'm not a nihilist. The tenor around for profit healthcare is seriously changing in this country. My guess is that the PBMs will do everything they can to milk pharmacies dry before they're hamstrung by regulations. In the meantime, those of you in independent pharmacies need to be working on a class action lawsuit.
A good majority of these bills are passing with unanimous votes. I'm an avowed pessimist, but I'm not a nihilist. The tenor around for profit healthcare is seriously changing in this country. My guess is that the PBMs will do everything they can to milk pharmacies dry before they're hamstrung by regulations. In the meantime, those of you in independent pharmacies need to be working on a class action lawsuit.
